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By Henry Uche
For decades, accessing quality and affordable Primary Health Care (PHC) in most parts of Nigeria has been a nightmare for concerned citizens. Strengthening PHC and achieving Universal Health Coverage (UHC) are two current Global Health Policy Initiatives that country leaders are expected to implement for their citizens. Unfortunately, Nigeria is still struggling to allocate an adequate budget for its health sector.
The government’s inability to budget adequate funds for this essential service is one of the major impediments to providing quality, affordable, and accessible Primary Health Care to citizens. Furthermore, mismanagement of available financial resources in this regard has been an albatross to achieving a reasonable PHC, among other factors.
To kick off, Ashiru Abubakar, an Associate at the Clinton Health Access Initiative, estimated that N2.7tr would be required over a 10-year period to get PHCs right in Nigeria. He stated this at Nigeria Health Watch’s 2022 Primary Health Care Policy Dialogue (held in Kano).
While examining the vulnerabilities of PHC funding in Nigeria, he stated that though this amount may be difficult to achieve, there are opportunities for ensuring long-term funding for PHC. For starters, donor agencies may become weary of providing financial assistance for obvious reasons. Second, a high rate of inflation, a large budget deficit, reprioritization, high debt servicing, and a global recession (including Covid-19), among other factors, could make meeting this financial need difficult.
Similarly, a lack of political will to do the necessary as and when required, an over-reliance on foreign aid, inconsistent policy, a lack of trust in government, and open corruption, among other factors, have made achieving the desired PHC a mirage.
Abubakar also stated that limited intersectional collaboration, verticalization of health programs, perceived poor quality of health care services, and the increasing double burden of diseases, including epidemics, are all factors that must be addressed head-on if PHC is to be provided.
Nonetheless, the possibilities seem limitless, as he advocated for revenue boost to increase fiscal space. For example, there is a need to expand health insurance coverages to reduce OPE at the point of care (BHCPF, SSHIAs, etc.), as well as private sector involvement through PPP, CSR-tax breaks/incentives, and adoption of a PHC model.
“Improving taxation policies (excise duty on beverages, alcohol, tobacco, etc.) is necessary.” Furthermore, increased funding for health and PHC should be targeted through budget and co-funding mechanisms.
“While plugging fiscal drainers such as subsidies and community-directed resource mobilization are essential, trust and confidence in government is critical to garner support across the board.” He emphasized the importance of strengthening strategic purchasing, which will entail a hybrid provider payment mechanism focused on people’s health (capitation) and incentive/performance (quality) for quality.
“In all levels of care and training, quality client satisfaction and experience of care should be mainstreamed, tracked, and recognized. Poor-quality care is wasteful, whereas high-quality care has a high Return on Investment (ROI).”
He posited that a strengthened public financial management system would go a long way toward closing the PHC loopholes. According to him, this includes inclusive planning with an emphasis on health promotion in primary care, as well as addressing the broader health determinants. Health promotion in primary care will free up resources that could be used to strengthen PHC; data-driven planning and budgeting in which allocations are made on a need-based basis and allocative efficiency is tracked.
Others include: reprogramming funds from disease-specific projects to strengthen PHC infrastructure, HRH, and capacity building; instituting robust accountability mechanisms via a financial management information system to create visibility into disbursed funds, track utilization, and systematically reduce corruption; and strengthening PHC managers’ capacity to identify, prioritize, and allocate available resources.
“Ensuring sustained funding for PHC is a deliberate political decision, not a technical one, owing to the trade-offs involved.” It necessitates a clear vision, sustained commitment, and consensus building among various stakeholders,” he added.
In her opening, Vivianne Ihekweazu, Managing Director of Nigeria Health Watch, stated that the dialogue was planned to bring together stakeholders from national and subnational governments, international organizations, the private sector and civil society organizations to pro-offer solutions to some of the human resources for health and funding gaps that limited service delivery in primary health care facilities.
According to Ihekweazu, in August 2021, Nigeria Health Watch launched the Community Health Watch project with the goal of reporting on PHC access and delivery in communities across Nigeria, as well as providing opportunities for community members and healthcare workers to share their experiences.
“We felt it was critical to organize this policy dialogue in Kano State in order to sustain these efforts and maintain the momentum gained during the recently held PHC Summit in March 2022, where ambitious goals for improving PHC were set.
“Given the importance of Human Resources for Health (HRH) in the delivery of healthcare services, and how financial constraints affect the provision of quality health care services, this dialogue is critical. Regardless of the oddities, the ultimate and common goal is to provide a cost-effective and funded quality care package of services to patients in PHCs,” she stated.
